Rates of teen visits to emergency departments for self-harm more than doubled since 2009

The number of teenagers landing in Ontario emergency departments because of self-harm more than doubled between 2009 and 2017, raising questions about what is driving the worrisome trend.

The research, led by Dr. William Gardner, senior scientist at the CHEO Research Institute, was published in the Canadian Journal of Psychiatry on Tuesday.

The findings surprised researchers, said Gardner.

“What we found was that yes, incidents of self-harm are increasing, and so are emergency department visits with mental health concerns. But I don’t think any of the study team members expected such a dramatic rise from 2009 to 2017.”

Teens who intentionally harm themselves by cutting or poisoning are at risk for repeated self-harm and suicide.

Although the data offers no evidence about what is behind the dramatic increase, its timing coincides with the introduction of the iPhone and more common use of smartphones in society.

The first iPhones were sold in Canada beginning in the summer of 2008, just before self-harm rates among teens began to jump. The use of smartphones has increased dramatically since then, especially among teens. Gardner said smartphone use could drive an increase in self-harm in several ways.

“Engagement with social media could lead to increased rates of self-harm, at least for vulnerable adolescents. This could happen in several ways: by normalizing self-harm, by triggering it, by getting teens to emulate self-harming peers, or by exposing youths to cyber bullying,” said Gardner. Social media might also benefit some troubled youths, he added, by providing them with a way to escape social isolation and encouraging them to seek treatment.

Smartphone use was not the only societal shift around 2009, although it might have been the most significant. The Bell Let’s Talk campaign, launched in 2010, is part of a larger movement to end stigma around mental illness. Gardner also said stress resulting from the 2008 financial crisis could have played a role in the increase.

The research, based on numbers from emergency departments across the province between 2003 and 2017, puts hard data on a trend being felt at hospitals and seen in communities in recent years.

The researchers found that rates of youth emergency visits for self-harm actually decreased by 32 per cent between 2003 and 2009 before increasing by 135 per cent between 2009 and 2017. Rates of mental health visits rose by 78 per cent between 2009 and 2017 for all youths. Rates of self-harm and mental health visits for females were higher and increased more quickly than for males.

Gardner, who is also a professor of epidemiology at uOttawa and senior research chair for child and adolescent psychiatry, said the findings raise concerns about treatment for adolescents presenting at emergency departments with mental health issues.

“We have hundreds of kids coming to Ontario emergency departments with these problems. The rate is going up every year. The rate is not slowing down. But the number of child psychiatrists at CHEO and child psychologists hasn’t changed over that period. The number of emergency department personnel hasn’t changed. That is really a problem.”

A shortage of child and youth mental health workers across the province has been widely reported on in recent years.

Researchers also note that while emergency departments are often the first contact that families have with the mental health system, they are not an ideal setting for the delivery of mental health services for adolescents who have self-harmed or are in crisis.

Community mental health follow-up after self-harm has been associated with a reduced chance of repeat self-harm, said Gardner.

“Efforts should be made to increase the supply of and access to evidence based treatments for adolescents who self-harm or have mental health problems. Where possible, it’s important to deliver these services to youth before they need to come to an emergency department.”

For the complete article see: https://journals.sagepub.com/doi/full/10.1177/0706743719854070